Case ReportDengue fever in patients under biologics
Section snippets
Why is this series important?
DF is an emerging mosquito-borne viral disease with over 50 million cases yearly in the world [1]. Worldwide there are 2.5 billion people living in developing countries who are at risk of DF. Biotherapies are monoclonal drugs or soluble receptor directly targeting cytokines (TNFα for etanercept and infliximab) or cells (B lymphocyte for rituximab) widely used in rheumatic diseases in countries which are currently not exposed to DF. Nevertheless their use in emerging countries, which are exposed
Cases description
From the aforementioned patients, nine were found, with a diagnosis of “confirmed” or “probable” DF as defined by the WHO [1]. Among these patients, none had haemorrhagic DF, 8 had confirmed DF and 1 had “probable DF” as defined by the WHO. The probable case was diagnosed on clinical signs in an epidemic context but with negative serology, so consequently this patient was removed from the analysis. Patient's characteristics are in Table 1.
Regarding DF, all patients had fever (low grade in two,
Other similar and contrasting cases in the literature
To our best knowledge, this is the first report of the occurrence of DF in patients taking biotherapies, antiCD20 or anti-TNFα.
Discussion
Patients on biotherapies are at increased risk of serious infections [3] either viral or bacterial, but no data has been published regarding DF. We didn’t see any severe cases of DF among our 293 patients on biotherapy (anti-TNF and anti-CD20) that experienced symptomatic DF. We believe, on account of the institutional survey, that we would not have forgotten the most severe cases, occurring in 1.6% according to the WHO. Whilst there is no human data regarding DF and individuals on biotherapy,
Funding
None.
Competing interests
None declared.
Ethical approval
Not required.
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